Healthcare Provider Details

I. General information

NPI: 1114218377
Provider Name (Legal Business Name): LOUISVILLE OPTOMETRIC CENTERS, III PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 E TIPTON ST STE 2
SEYMOUR IN
47274-3519
US

IV. Provider business mailing address

631 E TIPTON ST STE 2
SEYMOUR IN
47274-3519
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-4444
  • Fax: 812-522-2634
Mailing address:
  • Phone: 812-522-4444
  • Fax: 812-522-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. ROD L. RALLO
Title or Position: OWNER
Credential: O.D.
Phone: 502-459-2020